Melrose woman's family fate thwarted through colonoscopy

Thursday

Mar 4, 2010 at 12:01 AMMar 4, 2010 at 4:04 AM

When Melrose resident Aleksandra Nowak first met her now-husband, she admonished him with a dire warning. “I said, ‘listen, don’t fall in love with me — I may die at a really early age,’” Nowak said. Her warning came from watching her mother, grandmother, uncle and aunt who all died from colon cancer between the ages of 35 and 40.

Daniel DeMaina / ddemaina@cnc.com

When Melrose resident Aleksandra Nowak first met her now-husband, she admonished him with a dire warning.

“I said, ‘listen, don’t fall in love with me — I may die at a really early age,’” Nowak said.

Her warning came from watching her mother, grandmother, uncle and aunt who all died from colon cancer between the ages of 35 and 40.

Nowak, 27, could have faced a similar fate had she not undergone a colonoscopy. The test revealed more than 400 polyps stretching from her appendix to her rectum.

Nowak shared her story with the Free Press this week to stress the importance of colorectal screenings, her message coinciding with Colorectal Cancer Awareness Month in March.

With 655,000 deaths worldwide per year, colon cancer is the fifth most common form of cancer in the United States and the third leading cause of cancer-related death in the Western world, according to the World Health Organization.

Nowak’s family members all fell victim to the disease in her homeland of Poland, where she lived before moving to the U.S. seven years ago. Watching her loved ones all die from the same disease almost paralyzed Nowak with fear: Despite knowing her increased risk for colon cancer, she kept putting off going to the doctor for her own screening.

“I was 14 when my mother died,” she said. “I was scared and at the same time depressed … I decided to basically wait, hoping that I’m not going to have the bad gene — but unfortunately I had the bad gene.”

Family history is the main factor in determining whether someone faces an increased risk of colon cancer, according to Dr. David Siegenberg, a gastroenterologist and internist with Hallmark Health who is the featured speaker at a colon health session at Melrose-Wakefield Hospital on Thursday, March 25 (see sidebar for details).

“The short answer is that everyone is at risk for colon cancer,” Siegenberg said. “Males are as equally at risk as females. There’s some perception out there that it’s only a disease that affects males.”

While the average person with no risk factors should get their first colonoscopy around 50 years of age — and once every 10 years after that if the exam comes back normal — Siegenberg said that higher risk patients with a family history should undergo their first colonoscopy 10 years younger than when their relative was first diagnosed.

“If someone has a 55-year-old father who had colon cancer, then we say starting at age 45 they should have their first screening,” he said. “One thing that’s important to note is that we’re talking about average risk, asymptomatic patients who don’t have any symptoms. If they have symptoms [bleeding during bowel movements or significant changes in bowel patterns], they need to see a doctor right away.”

A loved one’s support leads to twist of fate

Even years after her family members died, fear of her own unknown fate still gripped Nowak, evident by the aforementioned warning she pressed upon her then-boyfriend and now-husband, Justin Gomolka, whom she met here in the U.S. while attending classes at Bunker Hill Community College.

Regardless of her admonishment, Gomolka stuck by her, eventually helping Nowak put aside her fears and visit a doctor. Upon doing so, she was immediately scheduled for a colonoscopy based on her family’s history.

“I was hoping for my father’s genes,” she said.

Unfortunately, she had her mother’s genes. Nowak’s colon, also called the large intestine, had 400 polyps, which are abnormal growths that can be either benign or cancerous, or can develop into cancer.

Siegenberg said that more than 90 percent of polyps can be removed at the time a colonoscopy is performed, with the patient advised to return in 3-5 years, instead of the usual 10 years, for a repeat colonscopy.

However, the sheer number of polyps found in Nowak’s colon required more drastic measures. Nowak’s doctor, Dr. Michael Thiim at Massachusetts General Hospital in Boston, told her that because the polyps had not spread to her upper intestine or abdomen, they could prevent her from ever developing colon cancer by removing her colon.

Siegenberg said that if colon cancer is discovered, improvements in surgical techniques and the use of a laparoscope — a tiny camera on a telescopic rod — have made the surgery less invasive and recovery times quicker. Further treatment depends on the result of the post-surgery pathology report and, in all cases, the patient is advised to have another colonoscopy within a year.

Nowak said she was told about options other than the common colostomy, in which the surgeon, after removing the colon, connects the intestine to a port in the patient’s abdomen, through which waste empties into a colostomy bag.

Another option was ileoanal anastomosis, commonly called J-pouch surgery, Nowak said, where over the course of two surgeries, the surgeon uses the small intestine to create an internal pouch that stores waste and connects to the anal canal.

Nowak underwent a colostomy at Mass. General on Dec. 29 and spent two weeks in the hospital.

“Everything was removed,” she said. “That saved me basically from having colon cancer in the future.”

Colon health information session at Melrose-Wakefield Hospital

Hallmark Health is holding an interactive session on colon health on Thursday, March 25 from 7-9 p.m. at Melrose-Wakefield Hospital, in the third floor boardroom.

Featured speaker Dr. David Siegenberg will discuss the importance of colon health as well as provide information on colonoscopies.

The session will also include a tour of the endoscopy unit, a chance to meet the staff, a discussion on the top 10 reasons why people avoid having colonoscopies, as well as information on prevention, detection and risk factors for colon cancer.

To register, visit hallmarkhealth.org, click on “Events Calendar” and select the event, or call 800-540-9191. The event is free, but registration is requested. Light refreshments will be served.

Options for tests, too

Colonoscopies aren’t the only option for screening for polyps or colon cancer, according to Siegenberg. While only gastroenterologists or surgeons who specialize in colorectal disease perform colonoscopies — in which a thin, flexible tube with a camera on the tip is inserted in into the anus and takes pictures of the colon and rectum — some family practice and primary physicians can conduct a sigmoidoscopy.

In a sigmoidoscopy, only a third of the colon is examined. Siegenberg said that test is not considered an adequate screening tool unless it’s combined with a stool test, with the doctor looking for evidence of hidden blood in the bowels.

Another option is a CT colonography, or a so-called ‘virtual colonoscopy,’ where a CT [computerized tomography] scan is used to examine the colon. President Barack Obama had a virtual colonoscopy performed as part of his routine physical exam last Sunday.

However, Siegenberg said that virtual colonoscopy isn’t as common because insurance companies typically don’t cover its use as a screening test.

“The advantage of that procedure is it’s less invasive and people don’t have to have an instrument used, but they still have to do a cleaning out,” he said, referring to what is called “bowel prep,” which includes the patient drinking only a liquid diet and taking a laxative the day before the procedure.

“The disadvantage is the test can be a little too sensitive, in the sense that it might pick up or suggest that there’s a lesion present and the patient will then have to undergo a colonoscopy anyway.”

Other than undergoing the proper screenings, Siegenberg said people can take of their colon health by eating a high fiber diet and drinking enough fluid each day, while avoiding too much red meat and fat. He also warned against advertised medications that claim to improve colon health through the use of laxatives.

“I don’t think that has shown at all to improve colon health,” he said. “Above all, don’t be afraid of colonoscopies. That’s something that deters patients from getting their initial screening colonoscopies.”

Today, Nowak remains cancer-free and she and her husband co-own a company called Best Bath Store, through which they sell organic and cruelty-free bath and body care products online at bestbathstore.com.

Nowak echoed Siegenberg’s exhortation for people to not fear colonoscopies.

“I was afraid, but after all, there’s nothing to be afraid of,” she said. “If they’re going to find something at an early stage, they can remove it and you can be perfectly fine … you cannot give up. Hope for the best. And you have to have a positive attitude. There are lots of emotions, worrying about your family and everything. It’s the positive attitude — just leave everything outside and focus on yourself and be optimistic.”